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Interviewing for cultural fit and retention

By Carol Westfall

There’s good fit – like a glove – or there’s bad fit – like socks on a rooster. In terms of an organization, fit has more to do with adapting to, and embracing an organization’s culture. The lack of a good fit is likely to result in turnover. In fact, the Cejka Search and AMGA Physician Retention survey has consistently found that “poor cultural fit” is the leading cause of turnover among physicians.

But what is “cultural fit”? A strong fit results when the new physician shares a majority of the practice’s mission, vision and values. When adding a new physician, fit figures as importantly as professional skills in assessing a long-term success potential. Professionally, Pavarotti would have been entirely capable of singing at the Grand Ol’ Opry, but there is little likelihood he would have been a good long-term fit. Poor fit causes endless hours of trauma and the breakup of many a professional match that seemed made in heaven.

There is both an art and science to assessing the organization’s culture – the organization’s core personality – including how that personality is projected and how to recognize compatible characteristics in a candidate. We call the collective personality the “glue” that binds an organization. The “glue” refers to the intangible characteristics displayed by individuals and the organization as a whole. It is important that an incoming physician exemplifies the basic character traits of the collective organization, or a serious misfit will occur.

Assess the Culture of Your Practice

All organizations have personalities. Before identifying a candidate’s cultural fit, a first step is to define the personality and culture of your medical practice. Whether Blue Chip or garden variety, an organization can have a personality that ranges from a professional elitism or coolness to very familial and down-to-earth. The same highly talented physician who is successful in the traditional, conservative, team-oriented organization would be disastrous in a high-flying, autonomous atmosphere. It is commonly believed that when an individual fails, it is because he or she lacked professional skills. However, the opposite is true. The failure is usually linked to fit rather than to skill base.

The following personalities can help you define the cultural orientation of your practice. These are just a few examples of traits that can define an organization’s culture, and few practices will fit purely into a single quadrant. But, becoming aware of the importance and value your organization places on these characteristics will help your interview team identify and define its own culture and make it easier to discover the candidate’s relative fit to your practice.


· Compassion.

· Access and patient satisfaction.

· Listening and approachability.

· Dealing with ambiguity.

· Interpersonal savvy.


· Planning and execution.

· Managing through systems.

· Priority setting.

· Process compliance.

· Focus on quality.

· Models preferred behaviors.


· History of achieving results.

· Driven to achieve.

· Accountability – self and others.

· Self-manages & self-corrects.

· Strong business acumen.

· Appropriately autonomous.


· Builds relationships.

· Responds to coaching & feedback.

· Integrity and trust.

· Social skills.

· Organizational agility.

· Loyalty.

Articulate Your Culture

Based on your assessment, be sure that you are sending a clear message about your culture and the expectations that are part of it. A practice’s mission and code of conduct should paint a clear picture. For example, a fictional medical group – Pleasant Valley Medical Partners – has become successful by providing a high level of customer service. Their mission statement reads as follows: “At Pleasant Valley Medical Partners, our mission is to put patients first and deliver exceptional customer service. We expect our physicians and staff to drop everything when it comes to taking care of a patient. Customer service also extends to our staff. We want them treated with respect and as important business partners.”

Evaluate whether your employee policies and operational practices support your cultural statement. Do those who are compatible with the culture enjoy recognition, advancement and job satisfaction? With this level of self-assessment in place, you will be able to evaluate how new physicians may fit into the culture you have created, as well as articulate a realistic picture of your practice to candidates and minimize post-hire surprises.

Develop a Behavioral Interview Approach

The interview is the single most important opportunity to assess the candidate’s fit. Everyone involved must stay focused on the goal of the interview, which is to reveal candidate’s true self. To ensure you achieve this goal, the interview team must share the philosophy that past behaviors predict future results. As people, most of us enjoy learning about others, asking questions and hearing the stories they have to tell. However, in a business situation, behavioral interviewing does not come naturally. It requires planning, training and discipline.

It is important to commit the time and resources necessary to develop the right questions and conduct thorough interviews. The team cannot be hurried or interrupted. You can build efficiency into your behavioral interviewing process by assigning each team member a particular topic he or she should cover. Then, develop sample questions and a system for sharing and evaluating the responses, so a full picture of the candidate will emerge.

Candidates give strong signals regarding their own set of fit factors during an interview. But because the practice’s needs may be great, or because during the interview you have come to like the candidate personally, you may ignore those signs. Too often, the interview team leads the candidate toward the “right answer” or fails to follow-up on an answer to get the specifics that will reveal the candidate’s true self.

To prepare for the interview, it is important to develop specific interview questions to access critical information. Using our example of Pleasant Valley Medical Partners, imagine asking a candidate if they believe it is important to put the patient first. Of course he or she will say “yes!” But that answer will not reveal how they will actually behave in your practice.

Behavioral interview questions for Pleasant Valley Medical Partners would follow these lines:

· Describe a time when you had to go out of your way to put a patient first.

· Describe your approach to customer service as it relates to patients and to the staff.

· Give me examples of when that approach worked, and when it didn’t work.

· Describe a patient case or encounter that generated a particular sense of compassion from you.

· Tell me how you have created an environment in the past where staff or patients are comfortable approaching you – even with bad news.

· Tell me about your relationships at work (with physician colleagues, administration, staff).

· Describe a favorite relationship and a difficult relationship.

· Describe a time when you provided recognition to a staff member.

· Give me an example of how you mediated a conflict in your office, department or organization.

You should follow the pattern of these general guidelines and follow-up questions:

Request details about specific situations:

· What?

· How?

· When?

· Who?

Press for specific results; ask probing questions:

· What did you do?

· Who else participated?

· What was their role?

· What did you say?

· What were you thinking?

· What problems did you encounter?

· How did you overcome the problem?

· What else did you do?

· What happened next?

The candidate who talks about colleagues and describes past achievements in terms of group activities is undoubtedly a team player. Similarly, a display of stellar individual performance and descriptions of solo achievements will almost always indicate a more independent performer. Outside activities are good indicators. Involvement in civic, charitable and family activities reveal a great deal about the candidate in terms of relationship-building and contribution. Remember that the candidate’s tendencies are neither good nor bad. They merely fit your organization’s culture or they don’t.

Be Patient and Consistent in Your Approach

It will take time to assess the culture of your practice and upgrade the skills of your interview team, but once you know the personality of your organization, you can begin to figure out what you’re looking for in a candidate and consistently apply your criteria to every interview.

Of course, there is no such thing as the perfect fit. If you happen to have an organization that is more like a happy family, you are undoubtedly involved in a tight-knit group. Adding an outsider to this group, no matter how good the fit, will forever alter the character of the organization. You may have some temporary (or permanent) discord no matter how well you’ve screened. That’s the people dynamic of recruitment and new hire transition into an established organization.

Many companies perceive new employees to lack fit factors, when what they lack is merely an education and proper enculturation. New employees do not inherently understand or buy into the group characteristics, but most will learn to fit if properly coached. Although companies frequently believe that new employees should innately understand them, there are many aspects to an organization and its people that are not readily apparent to an outsider. A sense of esprit de corps develops over time. Routinely seeing the big picture and integrating the organization’s mission into a new hire’s daily work should not be assumed. An effort must be made to introduce the organization and its people to the new physician, as well as permitting time for him or her to settle in.

Finally, there is no fail-safe method to assess a good long-term fit. But a careful appraisal of your organization, coupled with detailed explorations of the candidate’s personal and professional traits, will go a long way toward making good cultural matches and retaining them for the foreseeable future.

Carol Westfall is President of Cejka Search, a nationally recognized executive and physician search organization providing services exclusively to the healthcare industry for more than 25 years.

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